Provider Demographics
NPI:1194272476
Name:MAHAJAN, RUCHI GUPTA (MD)
Entity type:Individual
Prefix:
First Name:RUCHI GUPTA
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 KISSENA BLVD
Mailing Address - Street 2:APT 3 V
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2934
Mailing Address - Country:US
Mailing Address - Phone:347-330-1596
Mailing Address - Fax:
Practice Address - Street 1:4332 KISSENA BLVD
Practice Address - Street 2:APT 3 V
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2934
Practice Address - Country:US
Practice Address - Phone:347-330-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZMCI/10-37475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics